Ok, good morning. Look, we just got out of surgery for a patient who wrote to us. She has a giant cyst that they are going to see in surgery right now, but she also has an intramural myoma. The idea or the search was because she has not been able to get pregnant and wanted to get pregnant, but they also told her that they were going to remove her uterus and ovary as well because they thought it was cancer.

Remember, it is not necessary to remove the ovaries in simple cysts, cystadenomas, endometriotic cysts, teratomas, so knowledge is power. Call us and we can guide you.

I’ll give you a very simple example… It’s like if you get a blister on your finger and suddenly that blister grows a little bit bigger, even if it’s liquid, you go to the doctor, he examines you and tells you that he’s going to remove your finger or even your hand, the same thing happens here with the ovaries.

The vast majority of cystadenomas have liquid inside, you’ll see, and it’s very easy to preserve the ovary and obviously these cysts, even if they reach sizes of over 10 or 15 cm like the case we’re going to present, are generally benign.

This is the uterus, it would be the anterior face, here is the tube, the round ligament, round, tube has a completely subserous intramural right horn myoma and it goes to the posterior face, now we are going to try to exteriorize the cyst. Look, this is the tumor, it looks like a cystadenoma because of its consistency, there is no increased vascularity, I grabbed it here doctor and we see the stroma here at the base. Your tube is here, it is a cystadenoma cyst of the left ovary.

Yes, what I want is to surround it to remove everything from here and just leave the ovary.

Look, we are done, see how the ovarian stroma is left, obviously it is an ovary that is as if it had exploded from the inside because the tumor is very large, but we have already removed it completely, I think it is the first tumor that we have completed of more than 10 cm without breaking. See how everything is elongated, but look at what a good stroma, I think 80% of the ovary remains, so this patient is barely 33 years old, she is very young, so her ovary is obviously going to be preserved on this side, the fallopian tube, surely for reproduction, I don’t know if it is functional, but for in vitro it is definitely. Look at the right ovary, this is the fallopian tube, the fimbria, the ovary is very good, a little bit of adhesions but we are going with the myomectomy.

Look, it is a degenerated cystic myoma, we had already talked a lot about these types of myomas, sometimes they are easy to dissect, the problem is that they fuse with the capsule, the interface is lost and then the pedicle is very vascular, we are almost done. See, we have already finished the right tube, the right ovary which is normal, the left ovary which was elongated, here is the posterior surface of the uterus, it is finished, how all the posterior fundic musculature and the anterior surface are left, look how pretty, anterior surface, look how pretty your tube looks, here is the other tube but look here is the bladder, this is the bladder and here is where we make the incision to lower the bladder and do the cesarean sections, so the uterus on the anterior surface is free.

In this particular case, the patient obviously has a very good prognosis from a reproductive point of view, however, remember that since it is such a large tumor, what we did is we performed an intraoperative procedure. What does this mean? We removed the tumor from the left ovary and sent it to pathology for analysis. While they gave us the intraoperative results, we were able to perform the myomectomy, which lasted about an hour. The surgery lasted 2 hours in total, but we didn’t waste any time because we were waiting for the intraoperative procedure to perform the myomectomy.

We were repairing the uterus and that’s when they told us it was a benign cystadenoma, so the surgery ended there and we began to close the patient. It is important to perform a study on this patient afterwards, such as a myostero-salpingography, in order to see if both tubes are permeable and how they are visualized. Remember that she also had a large intramural myomectomy, so the products that lead to the fallopian tubes can often be blocked.

The important thing with this patient is: To decide if there is a way to get pregnant spontaneously, or if it is necessary to do a low complexity technique such as insemination or a high complexity technique such as in vitro fertilization with us.

The truth is that every day we face new challenges and it makes us very happy that, when we think that we have already done the most beautiful, most complex surgery, new cases always appear, such as when we removed the 9 kg myoma tumor and preserved the uterus, also when we removed a complete teratoma and in this case this cystadenoma cyst also of dimensions between 16 to 20 cm, where it managed to come out completely, so, this makes us very satisfied because it makes us feel and believe that we are doing things well, we have more and more foreign patients.